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doi:10.1136/tc.2005.0144642006;15;3-4Tob. Control
Research and Capacity Building Program"countries participating in the Fogarty International Center's "International TobaccoW Maziak, M Arora, K S Reddy, Z Mao and on behalf of researchers from developingdeveloping countriesOn the gains of seeding tobacco research in
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EDITORIAL
On the gains of seeding tobacco research in developingcountries
W Maziak, M Arora, K S Reddy, Z Mao, on behalf of researchers from developing countriesparticipating in the Fogarty International Centers International Tobacco Research and Capacity
Building Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tobacco Control 2006;15(Suppl I):i3i4. doi: 10.1136/tc.2005.014464
Aquestion central to the theme of this supplement to
Tobacco Control is why seed tobacco research in
developing countries? Arguably, research done in
advanced institutions can provide answers to most questions
regarding the hazards of smoking and ways to combat its
spread. Indeed, do we need to repeat in developing countries
expensive and lengthy cohort studies about the link between
smoking and cancer? Or should we investigate addiction
neurobiology in every population to better understand and
treat it? Obviously, there may be differences in cancer risk oraddiction neurobiology between populations, but are these of
a sufficient magnitude and relevance to tobacco control to
justify establishing such costly research programmes in
developing countries. These are justified arguments, yet the
question at hand is of much broader nature.
LOCAL DATA ESSENTIALWe have learned through the years that the smoking
epidemic follows a predictable course in most populations,
thus requiring fairly similar intervention strategies. Yet when
we begin planning tobacco control interventions in a
developing country setting, we immediately face basic
questions for which few answers exist, and for which data
from developed countries are inadequate, and sometimes
even misleading. More so, when threatened by the potentialadoption of anti-tobacco policies promoted by governments
and public health advocates in developing countries, the
tobacco industry often responds by highlighting the potential
negative economic impact of these policies and the inade-
quacy of local data justifying their implementation. Examples
of local data essential for the development of effective
tobacco control interventions include: patterns and trends
of tobacco use initiation and quitting in the society; the
applicability of interventions developed in different cultures
or rich societies (for example, tax increases); the toxic and
addictive profiles of local tobacco use methods (for example,
smokeless tobacco, waterpipe, and bidis) and the economic
toll of tobacco use for the target society compared to the costs
of establishing nationwide intervention programmes? These
are just a few examples of the scope and depth of datarequired to even begin planning intervention strategies to
curb tobacco use in the society, as well as to convince
policymakers of the rationale of investing in such interven-
tions.
An evidence-guided approach to tobacco control is parti-
cularly relevant to societies where limited resources necessi-
tate rationing expenditures to areas with the most potential
impact. Without negating the universal relevance of tobacco
control knowledge generated in developed countries, answers
to specific local questions are best generated by credible
research conducted within the target societies by people
native to the local environment and culture.
Evidently, the holy grail of tobacco research in developing
countries lies in finding the delicate balance between
required resources and potential benefits of the proposed
research agendas. Projects supported by the research and
capacity building initiative of the Fogarty International
Center commemorated in this supplement strive to achieve
this balance. As seen from contributions showcased in this
supplement, countries and regions that until very recently
had scarce standardised data about tobacco use, or scarce
national capacity to address the tobacco problem, have takenimpressive steps in these directions, thanks to this single
modestly funded (by international research standards)
initiative.
WI DE -R AN GI NG GA IN S FR OM SE ED IN G TO BA CCOCONTROL RESEARCH IN DEVELOPING COUNTRIESThe gains from building local research capacity and generat-
ing local data are critical, both for knowledge translation
(that is, identifying cost-effective and culturally appropriate
ways of applying available knowledge in the specific context
of each country), and new knowledge generation (that is,
addressing critical information gaps that act as barriers to the
initiation and implementation of tobacco control policies).
Equally important for developing countries is that successful
collaborations in tobacco-control research and building ofskilled local capacity can sprout new research in other health
areas, thus broadening the impact of such initiatives on the
public health landscape in developing countries. Indeed, as
work progresses in the projects funded by the Fogarty
initiative we see data generated on cardiovascular health,
environmental health, social and behavioural sciences, to
name but a few. Other than branching to other health
research areas locally, this initiative has led to new cross-
projects collaborations. An example of such emerging
collaborations is the Research Assistance Matching (RAM)
project developed in partnership between the Syrian Center
for Tobacco Studies and the Johns Hopkins Bloomberg
School of Public Health to help researchers in developing
countries connect and collaborate with experts in their field.
Noticeably, training of local personnel under this programme
was not confined to research methods, but involved researchsupport as well. Abiding by international standards for
research involving human subjects, institutional review
board approval of research protocols, and staff training and
accreditation in human subjects protection, was a novelty for
most developing countries researchers going into this
programme. In essence, activities arising from this single
initiative have in many instances laid down the foundation
for the culture of standardised research and evidence-based
public health in participant developing countries.
Gains of such initiatives, however, are by no means
confined to the developing countries. Knowledge generated
in developing countries can be relevant to large immigrant
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populations in developed countries, as well as to the study of
emerging public health issues that may be difficult to
evaluate fully within developed countries (for example, the
worldwide emergence of waterpipe smoking, the export of
bidis from India to the USA). Given the commitment with
which many developing countries have begun implementing
the World Health Organizations Framework Convention on
Tobacco Control (FCTC), research evaluating the progress of
national tobacco control programmes can also provide useful
information to developed countries that are slow to ratify or
implement the FCTC. Another area where partnerships withdeveloping country researchers could be especially productive
is the research related to tobacco industry documents.
Insights provided by these documents, enhanced by inputs
of local researchers on the activities of the tobacco industry in
different societies, can help to expose and thwart industrys
deception. Last but not least, in a world rushing to re-
galvanise along ethnic, cultural, and ideological fortifications,
such initiatives build bridges for sorely needed dialogue
and understanding between people and nations. Making
peace through cooperation is far less costly than any war or
conflict.
The impressive successes of this programme notwithstand-
ing, its impact is critically threatened of being short-lived if
not sustained further. Given the slow process of knowledge
accumulation and spread, it takes time to reach a momentum
whereby new knowledge is endorsed by the public and used
to influence policy. So despite the five-year length of the
funding cycle of the Fogarty initiative, the fact that most of
the initiated projects started from scratch means that this
period is invested mainly in training, establishing operations,
and generating baseline data. This limits the created research
groups ability to influence policy as well as achieve self-
sustainability. Transforming these research seeds into self-
sustaining research centres/programmes that can continu-
ously inform policy, as well as provide a model for research
excellence in their respective countries/regions, will certainly
require more resources, time and commitment.While the prospects for sustainability of this programme
remain in the realm of the future, the delight of friendship it
has generated is an everyday reality that we intend to cherish
as time goes by.
Authors affiliations. . . . . . . . . . . . . . . . . . . . .
W Maziak, Syrian Center for Tobacco Studies, SyriaM Arora, Health Related Information Dissemination Amongst Youth,IndiaK S Reddy, All India Institute of Medical Sciences, IndiaZ Mao, Sichuan University, China
Competing interests: none declared
Correspondence to: Wasim Maziak, PO Box 16542, Aleppo, SyrianArab Republic; [email protected]
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